Do governments give diabetes the attention it deserves?

Evidence from Australia and England suggests diabetes is an invisible condition

By Prof Jane Speight

One month ago, the Australian Government announced an inquiry into ‘Diabetes in Australia’. The full title is: “Inquiry into 1) the prevention, diagnosis and management of all forms of diabetes, and 2) obesity and its effects on the Australian population, including prevention, diagnosis and management”. It is not so much an inquiry, as half an inquiry. Half is into obesity and its effects. Why does an inquiry on diabetes give half the attention to obesity? Similarly, why is an inquiry into obesity mislabelled “Diabetes in Australia”? Is it because there is a stereotype that diabetes and obesity always go together? Is it because diabetes and obesity don’t deserve their own inquiries?

In England, the UK Government has called for evidence for a ‘major conditions strategy’. Diabetes is just part of the story, with a focus on six major groups of health conditions.  Diabetes is highlighted as a key example in the press release: “The major conditions strategy signals the government’s intention to improve care and outcomes for those living with multiple conditions and an increasing complexity of need. For example: people with diabetes are twice as likely to have depression”.

Yet, diabetes appears to be a low priority in the call:

      • Diabetes is mentioned once in the Consultation Description of the Call for evidence. This call seeks views on six major conditions. The second is ‘cardiovascular disease, including stroke and diabetes’. Obesity is not mentioned at all.
      • Diabetes is mentioned once in the Executive Summary of the Call for evidence.
      • Diabetes is not mentioned in the main text or Questions of the Call for evidence.
      • Diabetes is mentioned once in the 41-page ‘easy read’ version (see Boxes 1 to 3).

Box 1. Question 9 asks “what is your health condition?”. Diabetes is listed 16th in a list of 16 conditions.

Box 2. Question 15 asks “Which illnesses causing bad health and early death would you like to answer questions about? Tick all that apply.” 6 conditions are listed. Diabetes is not in the list.

Box 3. Questions 16 to 20 ask “What are the most important things that we should do first?” They refer specifically to 4 conditions. Diabetes is not on the list.

Perhaps, this is not specific to diabetes. Perhaps, it happens in other areas of health. Almost certainly this is the case for obesity.

A brief search of the Australian Government’s Committees and Inquiries shows one inquiry into diabetes (above) since 2010. The same is true for obesity. There have been eight inquiries into cancer since 2010. These include a current inquiry into rare forms of cancer, with well-framed questions regarding barriers to screening, diagnosis, access to treatments, adequacy of support services, and adequacy of Commonwealth funding for cancer research. Further, in the UK Government’s call about ‘major conditions’, cancer also gets top spot and dedicated questions. Yet, it was also the focus of a dedicated call ’10-year cancer plan: call for evidence’ less than 18 months ago in the UK.

This is an example of diabetes stigma and discrimination. You can read our other blogs about diabetes stigma here. We have also recently published a commentary about this issue. People with diabetes wait years for inquiries and strategies. Such calls have the power to make a difference to the care they receive. But, instead of diabetes getting the attention it deserves – instead of people with diabetes getting the attention they deserve – diabetes is stereotyped, and the consultations are biased.

National Diabetes Week has just concluded in the UK (12-18 June) and is just around the corner in Australia (9-15 July). In Australia, the recent three-year National Diabetes Week campaign 2020-2022 ‘Heads Up on Diabetes’ called for a rethink of diabetes:

Let’s reduce the burden with more compassion.
Let’s reduce the blame with more understanding.
Let’s reduce the barriers and help people get support.
Let’s rethink diabetes.

Unfortunately, it seems this message has not landed with politicians and policy makers. Diabetes stigma is all around us. It is not just about how people feel. Diabetes stigma goes to the heart of policy and funding decisions. Diabetes stigma needs to stop. But, to bring an end to diabetes stigma, we need collective action.

Anyone can submit a response to these important calls:

The ACBRD will submit a response to the Australian inquiry. We encourage everyone living with diabetes ,or supporting someone with diabetes, to submit a response. Even just a few lines to indicate that the lack of priority for diabetes is not ok. Be part of the collective action we need to end diabetes stigma.

Visit Heads Up on Diabetes to find out more about the National Diabetes Week 2020-2022 campaign and resources.

Disclaimer: I have led a program of work focused on diabetes stigma since 2011. The ACBRD owns the copyright of scales to assess the stigma surrounding type 1 and type 2 diabetes (DSAS-1 and DSAS-2). I was an advisor to Diabetes Australia on the ‘Heads Up on Diabetes’ campaign. The ACBRD has partnered with the diaTribe Foundation to dStigmatize diabetes.